Criteria Flashcards
NYHA functional classification for CHF: general
measure of severity of heart failure
Class I - mild
Class II - mild
Class III - moderate
Class IV - severe
NYHA functional classification for CHF: class i
Mild
Patients with cardiac disease but without resulting in limitation of physical activity.
Ordinary physical activity does not cause undue fatigue, palpitation (rapid or pounding heart beat), dyspnea (shortness of breath), or anginal pain (chest pain).
NYHA functional classification for CHF: class ii
mild
Patients with cardiac disease resulting in slight limitation of physical activity.
They are comfortable at rest.
Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain
NYHA functional classification for CHF: class iii
moderate
Patients with cardiac disease resulting in marked limitation of physical activity.
They are comfortable at rest.
Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
NYHA functional classification for CHF: class iv
Severe
Patients with cardiac disease resulting in the inability to carry on any physical activity without discomfort.
Symptoms of heart failure or the anginal syndrome may be present even at rest.
If any physical activity is undertaken, discomfort is increased.
What is CHADS2VASC score used for?
used determine the treatment plan with patients that have atrial fibrillation
What do you do for the different CHADS2VASC scores?
0 aspirin or no antithrombotic
1 aspirin or anticoagulation (warfarin)
2+ These patients are typically put on heparin and bridged with warfarin to an INR of 2-3
USPSTF Screening recommendations
REVIEW
when is AAA screening recommended?
one-time screening abdominal US indicated in all men of 65-75 years of age who have ever smoked
TIMI risk score for unstable angina and NSTEMI: general
Estimates mortality for patients with unstable angina and non-ST elevation MI.
TIMI risk score for unstable angina and NSTEMI: factors/scoring
All one point: Age ≥65 ≥3 CAD risk factors --- (Hypertension, hypercholesterolemia, diabetes, family history of CAD, or current smoker) Known CAD --- (stenosis ≥50%) ASA use in past 7 days Severe angina --- (≥2 episodes in 24 hrs) EKG ST changes ≥0.5mm Positive cardiac marker
TIMI risk score for unstable angina and NSTEMI: interpretation
Patients with a score of 0 or 1 point are at lower risk of adverse outcome (death, MI, urgent revascularization) compared to patients with a higher risk score. However, the risk is not zero.
Patients with a higher risk score may require more aggressive medical or procedural intervention.
Duke criteria for infectious endocarditis: general
Diagnostic criteria for endocarditis.
Consists of pathological criteria, major clinical criteria, and minor clinical criteria
Duke criteria for infectious endocarditis: pathological criteria
If either is positive, diagnosis is definite:
Microorganisms in a vegetation
— Demonstrated by culture or histologic examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen.
Pathologic Lesions
— Vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis.
Duke criteria for infectious endocarditis: major criteria
If both are positive, diagnosis is definite:
Blood cultures positive for endocarditis
— Typical microorganisms consistent with IE from 2 separate blood cultures, microorganisms consistent with IE from persistently positive blood cultures, single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800.
Evidence of endocardial involvement
— Echocardiogram positive for IE, abscess, new partial dehiscence of prosthetic valve, new valvular regurgitation. Note: Worsening or changing of pre-existing murmur NOT sufficient.
Duke criteria for infectious endocarditis: minor criteria
If all are positive, diagnosis is definite:
Predisposing heart condition or injection drug use
Fever
Vascular phenomena
— Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway’s lesions.
Immunologic phenomena
— Glomerulonephritis, Osler’s nodes, Roth’s spots, and rheumatoid factor.
Microbiological evidence
— Positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE.
Child’s classification to assess severity of liver disease
https://www.2minutemedicine.com/the-child-pugh-score-prognosis-in-chronic-liver-disease-and-cirrhosis-classics-series/
Jones criteria for acute rheumatic fever: general
Diagnostic :
1 Required Criteria and 2 Major Criteria and 0 Minor Criteria
OR
1 Required Criteria and 1 Major Criteria and 2 Minor Criteria
Jones criteria for acute rheumatic fever: required criteria
Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase
Jones criteria for acute rheumatic fever: major criteria
Carditis Polyarthritis Chorea Erythema marginatum Subcutaneous Nodules
Jones criteria for acute rheumatic fever: minor criteria
Fever
Arthralgia
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
Light’s criteria for exudative pleural effusion: general
used to determine if pleural fluid is exudative (represents an alteration of the local factors that then precipitates a pleural fluid accumulation)
based on protein parameters and LDH parameters
Light’s criteria for exudative pleural effusion
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH Upper Limit of Normal
screening tests are used to diagnose diabetes mellitus
Fasting plasma glucose ≥ 126 mg/dL,
random plasma glucose ≥ 200 mg/dL with symptoms (polyuria and polydipsia),
hemoglobin A1C ≥ 6.5%, or
a 2-hour plasma glucose ≥ 200 mg/dL after 75 gram oral glucose tolerance test.
These same test should be repeated to confirm the diagnosis unless signs of metabolic decompensation (diabetic ketoacidosis or hyperosmolar hyperglycemic state)
CKD Staging
1 Normal or High > 90 2 Mildly decreased 60-89 3 a Mild to moderately decreased 45-59 3 b Moderate to severely decreased 30-44 4 Severely decreased 15-29 5 Kidney failure < 15
Behcet’s syndrome dx criteria
recurrent pathos ulcers (defined as at least 3 episodes within a 12-month period) plus two of the following:
Recurrent genital ulcers, commonly involving the scrotum in men and labia in women and sparing the glans penis and urethra. Ulcers commonly heal within 1-2 weeks with scarring.
Eye lesions, including anterior or posterior uveitis, hypopyon, retinal vasculitis, cystoid macular degeneration.
Skin lesions, including folliculitis, erythema nodosum, and/or acne-like exanthem.
Positive pathergy test, a diagnostic test that involves irritating the skin with a sterile needle. A positive result is marked by the formation of a erythematous papule 2 mm in diameter or larger that within 48 hours
Normal: T-score
> -1 SD
Osteopenia: T-score
< -1 and > -2.5
Osteoporosis: T-score
< -2.5
orthostatic hypotension
one or both of:
systolic 20mmHg
diastolic 10mmHg
within 2-5min of quiet standing after 5min supine rest
lung cancer screening
annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.
Screening should be discontinued once a person has not smoked for 15 years or already gonna die
GCS parameters
eye opening
verbal response
motor response
GCS: eye opening points
1 = none 2 = response to pain 3 = response to verbal command 4 = spontaneous
GCS: verbal response points
1 = none 2 = incomprehensible 3 = inappropriate words 4 = confused 5 = oriented
GCS: motor response points
1 = none 2 = extension to pain (decerebrate) 3 = flexion to pain (decorticate) 4 = withdrawal to pain 5 = localizing to pain 6 = obey's commands
Charcot’s triad components
RUQ pain
fever
jaundice
means ascending cholangitis
Reynold’s pentad components
Charcot’s triad (RUQ pain, fever, jaundice)
+ hypotension
+ AMS
means ascending cholangitis
3 most common AIDS-defining illnesses
(CD4<200 with)
pneumocystis pneumonia (40%)
cachexia in the form of HIV wasting syndrome (20%)
esophageal candidiasis
others:
opportunistic pathogens (coccidioidomycosis, cryptococcosis, cryptosporidiosis, disseminated CMV disease, refractory HSV infections, histoplasmosis, Mycobacterium tuberculosis, toxoplasmosis),
HIV encephalopathy, and
particular neoplasms (cervical cancer, Kaposi’s sarcoma, CNS lymphoma, Burkitt’s lymphoma)
SIRS
2 or more of the following variables.
Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
Heart rate of more than 90 beats per minute
Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
Abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature [band] forms)
Sepsis
SIRS with a source of infection
Severe sepsis
sepsis with end-organ damage
confusion, hypotension systolic blood pressure < 90 mmHg or mean arterial pressure < 70 mmHg that responds to fluids
Septic shock
persistent hypotension and perfusion abnormalities despite adequate fluid resuscitation
What is Ann Arbor staging system
staging system for lymphomas, both in Hodgkin’s lymphoma and non-Hodgkin lymphoma .
Stage options in Ann Arbor staging system
Stage I Stage II Stage III Stage IV Sub-stage A Sub-stage B
Ann Arbor Stage I
Localized to a single lymph node or extralymphatic site
Ann Arbor Stage II
Multiple lymph nodes or limited extralymphatic site on the same side of the diaphragm
Ann Arbor Stage III
More than two sites on both sides of the diaphragm
Ann Arbor Stage Iv
Diffuse or disseminated disease
Ann Arbor Sub-stage A
No constitutional symptoms
Ann Arbor Sub-stage B
Constitutional symptoms (fever, night sweats, weight loss)
Hemorrhagic shock classes
- Class I hemorrhage involves a blood volume loss of up to 15% or approximately 750 cc of blood.
- Class II hemorrhage occurs when there is a 15 to 30% blood volume loss, approximately 750-1500 cc of blood,
- Class III hemorrhage involves a 30 to 40% blood volume loss, about 1500-2000 cc of blood
- Class IV involves more than 40% blood volume loss, greater than 2 liters of blood
Sx of class I hemorrhagic shock
normal vital signs including heart rate, blood pressure, and pulse pressure,
may present with some anxiety.
Sx of class II hemorrhagic shock
tachycardia (heart rate of 100 to 120/min), tachypnea (respiratory rate of 20 to 24/min), anxiety, and a normal systolic blood pressure with decreased pulse pressure. The skin may be cool and clammy, and capillary refill may be delayed.
Sx of class III hemorrhagic shock
ignificant drop in systolic blood pressure and changes in mental status. Heart rate is increased (≥120/min ) and respiratory rate is also markedly elevated. Urine output is decreased and capillary refill is delayed.
Sx of class IV hemorrhagic shock
significant decrease in blood pressure and mental status. Tachycardia is present often greater than 140/min. Urine output is minimal or absent. The skin is cold and pale, and capillary refill is delayed.
Rome Criteria for IBS
- All patients must experience at least 12 weeks or more (not necessarily consecutive) of abdominal discomfort or pain in the past year.
- At least two of the three must accompany the pain: relief with bowel movements, onset associated with change in stool frequency, onset associated with change in stool appearance.
- Patients may also experience passage of mucus, abdominal distension, or abnormal stool frequency, form, or passage.
